The Bombay Shops and Establishment Act 1948 (as amended in 1956)

µÛà ¼ÛÛé¾¼Ûé ÉÛÛ鸡ö …鶦ø …éͤøÛ¼ÅÛàÉÛ¾Û鶤ø …鏤ø 1948 (1956 ¶ÛÛ ÍÛäµÛÛÁõÛ ¾Ûä›÷¼Û)

FORM “ A ”

ºõÛé¾ÛÙ “ …é ”
Statement under section 7(1) [See Rule 5]
õÅÛ¾Û 7(1) Ðéü¥øÇ ¶Ûà˜Ûé¶Ûä× Í¤éø¤ø¾Û鶤ø [›ä÷…Ûé õÛ¶Ûä¶Û 5]

1. Name of the establishment if any,

:
ÍÛ×ͬÛÛ …•ÛÁõ ¸Ûé§øà¶Ûä× ¶ÛÛ¾Û (›÷Ûé ÁõÛ”¿Ûä× ÐüÛé¿Û ©ÛÛé)
2. Postal address and situation of the
establishment :
ÍÛ×ͬÛÛ (¸Ûé§øà) ¶Ûà ›÷•¿ÛÛ¶Ûä× Í¬ÛÇ ©Û¬ÛÛ ¤ø¸ÛÛÅÛ¶Ûä× ÍÛÁõ¶ÛÛ¾Ûä×.
3. Situation of office, storeroom, godown,
warehouse, or workplace if any, attached to a
shop but situated in premises different from
those of the shop.
:
−äùõÛ¶Û …וÛé¶Ûà …ÛéºõàÍÛ, ͤøÛéÁõÄõ¾Û, •ÛÛé¦øÛŠ¶Û (ÈÛ”ÛÛÁõ),
ÈÛéÁõÐüÛŠÍÛ …¬ÛÈÛÛ õÛ¾Û õÁõÈÛÛ¶Ûà ›÷•¿ÛÛ¶Ûä× ¥éøõÛ¨Ûä× ›÷Ûé ¾ÛæÇ /
−äùõÛ¶Û¬Ûà ›ä÷−ùà ›÷•¿ÛÛ…é (¸Ûóà¾ÛÛ†ÍÛàÍÛ¾ÛÛ×) …ÛÈÛéÅÛÛ ÐüÛé¿Û
©ÛÛé.
4. Name of the employer
:
õÛ¾Ûé ÁõÛ”Û¶ÛÛÁõ (¾ÛÛÜÅېõ) ¶Ûä× ¶ÛÛ¾Û
5. Residential address of the employer
:
õÛ¾Ûé ÁõÛ”Û¶ÛÛÁõ (¾ÛÛÜÅېõ) ¶Ûä× ÁõÐéüÈÛÛ¶Ûä× ÍÛÁõ¶ÛÛ¾Ûä×
6. Name of the Manager if any, and his
residential address. :
¾Ûé¶Ûé›÷Áõ¶Ûä× ¶ÛÛ¾Û ›÷Ûé ÐüÛé¿Û ©ÛÛé …¶Ûé ©Ûé¶Ûä× ÁõÐéüÈÛÛ¶Ûä× ÍÛÁõ¶ÛÛ¾Ûä×.
7. Category of the establishment i.e. whether
shop, commercial establishment, residential
hotel, restaurant, eating house, theatre or
other place of public amusement or
entertainment. :
ÍÛ×ͬÛÛ¶ÛÛé ¸ÛóõÛÁõ, −äùõÛ¶Û, ÈÛé¸ÛÛÁõà ¸Ûé§øà, ÁõÐéüÈÛÛ ÍÛäÈÛÛ¶Ûà
ÍÛ•ÛÈÛ¦ø©ÛÛÈÛÛÇà ÐüÛé¤øÅÛ, ÁéõͤøÛÁé õ¶¤ø, ½ÛÛé›÷¶Û•ÛèÐü, ¬Ûà…é¤øÁõ
…¬ÛÈÛÛ õÛé†¸Û¨Û ÍÛÛÈÛÙ›÷ܶېõ ¾Û¶ÛÛéÁ×õ›÷¶Û …¬ÛÈÛÛ ”ÛÛ¶Û-
¸ÛÛ¶Û¶Ûà ›÷•¿ÛÛ
8. Name of the business
:
µÛ×µÛÛ¶ÛÛé ¸ÛóõÛÁõ (µÛ×µÛÛ¶Ûä× ÈÛ¨ÛÙ¶Û)
9. Date of commencement of business
:
µÛ×µÛÛé ÉÛÄõ õ¿ÛÛÙ¶Ûà ©ÛÛÁõà”Û
10. Name of the members of employer’s family
employed in the establishment
ÍÛ×ͬÛÛ¾ÛÛ× õÛ¾Û õÁõ©ÛÛ õÛ¾Ûé ÁõÛ”Û¶ÛÛÁõ (¾ÛÛÜÅېõ) ¶ÛÛ äõ¤ä×ø¼Û¶ÛÛ
ÍÛ½¿ÛÛé¶ÛÛ ¶ÛÛ¾Û
Adults Men ¸ÛäÂúÌÛ :
¸Ûä”©Û Š¾ÛÁõ Women ͪÛà…Ûé
Young persons ¶ÛÛ¶Ûà ‹¾ÛÁõ¶ÛÛ ¾ÛÛ¨ÛÍÛÛé
Total äõÅÛ
11. Name of other persons occupying position of
Management or Employees engaged in
confidential capacity (indicate sex and age in
case of young persons). :
ÈÛÜÐüÈÛ¤ø õÁõ¶ÛÛÁõ¶ÛÛé ÐüÛé°ùÛé µÛÁõÛÈÛ©ÛÛ …¬ÛÈÛÛ ”ÛÛ¶Û•Ûà
¸ÛóõÛÁõ¶ÛÛ õÛ¾Û¾ÛÛ× ÁõÛéõÛ¿ÛéÅÛÛ ¼Ûà›÷Û õÛ¾Û õÁõ¶ÛÛÁõ¶ÛÛ ¶ÛÛ¾Û
(¶ÛÛ¶ÛÛ ÉÛ”ÍÛÛé ¾ÛÛ¤éø ‹¾ÛÁõ ©Û¬ÛÛ ›÷ÛÜ©Û ›÷¨ÛÛÈÛÛé)
12. Total number of employees
õÛ¾Û õÁõ¶ÛÛÁõ (•Ûä¾ÛÛÍ©ÛÛ) ¶Ûà äõÅÛ ÍÛ×”¿ÛÛ
Adults Men ¸ÛäÂúÌÛ
:
¸Ûä”©Û Š¾ÛÁõ Women ͪÛà…Ûé
Young persons ¶ÛÛ¶Ûà ‹¾ÛÁõ¶ÛÛ ¾ÛÛ¨ÛÍÛÛé
Total äõÅÛ
Date Signature of the Employer
©ÛÛÁõà”Û ¾ÛÛÜÅېõ¶Ûà ÍÛÐüà
Note:-
1. This statement shall be sent to the Inspector of the local area concerned with such fees
as are prescribed in schedule.
2. Item 3 should be filled only when the office, storeroom, etc. is not separately
registered under the Act, in respect of such office, storeroom, etc. particulars are
required under 10, 11 & 12 should be given separately in this statement.
1. …Û Í¤éø¤ø¾Û鶤ø ¸ÛÜÁõÜÉṲ̂ø 1 ¾ÛÛ× −ùÉÛÛíÈÛéÅÛà ºõà ÍÛÛ¬Ûé …Û …וÛé¶ÛÛ Í¬ÛÛܶېõ (•Ûä¾ÛÛÍ©ÛÛ µÛÛÁõÛ …וÛé¶ÛÛ) …ܵېõÛÁõà¶Ûé
¾ÛÛéõÅÛÈÛä×.
2. …Û†¤ø¾Û ¶Û×¼ÛÁõ 3 ÍÛÛ¾Ûé¶ÛÛ ÜÈÛ•Û©Û …ÛéºõàÍÛÛé, ͤøÛéÁõÄõ¾Û, ÜÈÛ•ÛéÁéõ ›ä÷−ùÛ Áõœ÷ͤøÁõ ¶Û õÁõÛÈ¿ÛÛ ÐüÛé¿Û ©ÛÛé ›÷ ½ÛÁõÈÛÛ¶Ûà
™öé. …ÛÈÛà …ÛéºõàÍÛÛé, ͤøÛéÁõÄõ¾ÛÛé, ÜÈÛ•ÛéÁéõ ¾ÛÛ¤éø …Û†¤ø¾Û ¶Û×¼ÛÁõ 10, 11 …¶Ûé 12 ÍÛÛ¾Ûé¶Ûà ¾ÛÛÜÐü©Ûà …Û
ͤéø¤ø¾Û鶤ø¾ÛÛ× ›ä÷−ùà …Û¸ÛÈÛà.
›ä÷…Ûé õÛéÅÛ¾Û 18 (1)
¸ÛóÜ©Û,
¼ÛÛé¾¼Ûé ÉÛÛ鸡ö …鶦ø …éͤøÛ¼ÅÛàÉÛ¾Û鶤ø 1948 …¶ÈÛ¿Ûé¶ÛÛ †¶Í¸Û鏤øÁõ
1. ¾ÛÛÜÅېõ¶Ûä× ¶ÛÛ¾Û: ________________________________________________.
2. ÍÛ×ͬÛÛ¶Ûä× ¶ÛÛ¾Û ›÷Ûé ÐüÛé¿Û ©ÛÛé: ________________________________________________.
3. ÍÛ×ͬÛÛ¶Ûä× ¤ø¸ÛÛÅÛ¶Ûä× ÍÛÁõ¶ÛÛ¾Ûä×: ________________________________________________.
4. Áõœ÷ͤøÁõ ÍÛ¤øâºõàéõ¤ø ¶Û×¼ÛÁõ: ________________________________________________.
5. µÛ×µÛÛ¶ÛÛé ¸ÛóõÛÁõ: ________________________________________________.

…¾ÛÛé …¾ÛÛÁõà Š¸ÛÁõ ›÷¨ÛÛÈÛéÅÛà ÍÛ×ͬÛÛ / ¸Ûé§øà ˜ÛÛÅÛä ÍÛÛÅÛé ____________________ ¬Ûà ÉÛÄõ ¬Û©ÛÛ× ÈÛÌÛÙ¾ÛÛ× ©ÛÛÁõà”Û
____________ ¬Ûà ©ÛÛÁõà”Û ____________ ÍÛäµÛà −ùÁéõõ ______________ ÈÛÛÁõ¶ÛÛ ÁõÛé›÷ ¼Û×µÛ ÁõÛ”Ûà …¥øÈÛÛܦøõ
Áõ›÷Û ¸ÛÛÇàÉÛä× ©Ûé¶Ûà ¶ÛÛêµÛ ÅÛéÉÛÛéœ÷.

©ÛÛ. ____________ ¾ÛÛÐéü ____________ ÈÛÌÛÙ ____________ ¾ÛÛÜÅېõ / ¾Ûé¶Ûé›÷Áõ¶Ûà ÍÛÐüà